Male infertility: an emerging issue.
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Humans↗
Biomedical subjects
N I Siddiqui
Publications and source records attributed to N I Siddiqui.
Combined occurrence of hyperthyroid Graves' and Hashimoto's thyroiditis.
A 40 years old, married Govt. servant from Sadar upazila, Mymensingh was admitted in Mymensingh Medical College Hospital on 9(th) February, 2005 with the complaints of excessive sweating for 1 year, gradual loss of weight for 6 months, swelling in front of the neck for 1(1/2) months, and hoarseness of voice for 1 month. He was nervous, irritable, emotionally labile. Thyroid gland was symmetrically enlarged, firm in consistency with scalloped surface. Palms were warm and sweaty with fine tremor in outstretched hands. Lid lag, lid retraction and proptosis were the occular manifestations. All the reflexes were exaggerated. Radioactive iodine uptake showed enlarged gland with homogenously increased radiotracer concentration, ultrasonogram findings were enlarged gland with hypoechoic parenchyma with fibrous septa, T(3), T(4), TSH values were 6.56 nmol/L, 241.09 nmol/L and 0.14 mIU/L respectively. Thyroid microsomal antibody level was 32.87%. Thyroid FNAC findings were sheets of regular follicular cells, some large cells with granular basophilic cytoplasm, macrophages, a few inflammatory cells and giant cells. All the above findings were in favour of a diagnosis of hyperthyroid Graves' with Hashimoto's thyroiditis.
Adult↗
Insulin sensitizers: past, present and future.
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Diabetes Mellitus, Type 2↗
Effects of prolonged use of injectable hormonal contraceptive on serum lipid profile.
The current study was carried out to determine serum levels of total cholesterol, triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in human female volunteers taking injectable hormonal contraceptives. For this purpose, 200 (two hundred) subjects with age range of 20-35 years were selected. Out of them, 140 (one hundred and forty) were experimental subjects and 60 (sixty) were control. Women without hormonal contraceptive were selected as the subjects of control group. The experimental subjects were taking injectable hormonal contraceptive, DMPA (depo-medroxyprogesterone acetate) for 3-5 years uninterruptedly. The mean serum total cholesterol and mean serum triacylglycerol levels of the DMPA users were significantly (P 0.05). The mean serum LDL-cholesterol level of the subjects of DMPA users was significantly (P<0.05) elevated in comparison to that of the control.
Adult↗
Angiographic severity and extent of coronary artery disease in patients with type 2 diabetes mellitus.
Coronary angiographic characteristics of fifty patients with type 2 diabetes mellitus and coronary artery disease (CAD) were compared with fifty non diabetic patients with CAD. Type 2 diabetic patients undergoing clinically indicated elective coronary angiography were individually matched with fifty non diabetic coronary artery disease patients for age, sex and major risk factors. No significant difference was present between the mean age, presenting complains and other coronary risk factors between the two groups. Severity and extent of coronary artery involvement was assessed by a coronary artery score (CAS) using the segmental distribution method for coronary artery lesions and morphometric analysis of atherosclerotic lesion was done. Type 2 diabetic patients had a higher CAS (11.74+/-5.04 vs 8.72+/-4.87; P<0.001) as compared to the non-diabetic patients. Multivessel disease were more prevalent in both the groups (82% vs 68%; P>0.05) but diabetic patients had significantly higher number of triple vessel disease (58% vs. 38%; P<0.001). Normal coronary arteries and single vessel disease were more prevalent in non-diabetic patients (32% vs. 18%; P<0.05). As compared to non-diabetic group diabetic patients had a higher total number of diseased vessels (78.66% vs. 68%; P<0.01), a higher lesion per patient ratio (3.94+/-1.80 vs 3+/-1.67:P<0.001) and more proximal lesions (40.83% vs. 34.70%; P>.05) though not statistically significant. Morphometric analysis of coronary artery lesions revealed that diabetic patients had significantly higher number of multiple irregularity lesions (24.37% vs. 15.33%; P<0.01) and lesions were more obstructive (lesion involving 70-90% of coronary lumen: 70.53.% vs. 57.33%; P<0.05). Though there was no significant difference between the systolic left ventricular function between the two groups but significant higher regional wall motion abnormality was found more in diabetic patients (76%vs 62%; P<0.01). So type 2 diabetic patients had more severe and extensive atherosclerotic lesion in their coronary arteries than the matched non diabetic control on coronary angiography suggesting an independent effect of diabetic mellitus on atherosclerotic process specially in our population.
Adult↗
Budd-Chiari syndrome.
A 30 years old, non-alcoholic farmer from Trishal, Mymensingh was admitted in Mymensingh Medical College Hospital on 7 February, 2004 with the complaints of gradual swelling of abdomen, both legs and upper abdominal pain for 3 months. For the last 6 years, he was treated as a case of chronic liver disease (CLD) with spironolactone and frusemide. He was non-icteric, mildly anaemic with mild oedema, clubbing, gynaecomastia and engorged vein over anterior abdominal wall, flanks and back. Direction of venous flow was from below upward. There were mild hepatosplenomegaly, ascites and bilateral testicular atrophy. He was diagnosed as a case of Budd-Chiari Syndrome (BCS) on the basis of physical examination and it was confirmed by the findings of ultrasonography, liver scan and doppler study. The patient was managed by medical therapy alone.
Adult↗
Serum zinc status of rural women taking combined OC.
This prospective case-control study was undertaken on 78 women between 15 to 45 years of age from rural area to see alteration of serum zinc due to oral contraceptive (OC) use. Of the subjects, 34 women was taken as controls having no history of taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. All of the women in the control group were advised to start consuming oral pill (Sukhi) for 3 consecutive cycles and at the 3(rd) month, 25 women were taken as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for 4 months onwards. Subjects were classified as follows on the basis of duration of oral contraceptive use: Group I (n=34) -- controls, Group II (n=25) -- 3 months, Group III (n=17) -- 4 months -- 2 years and Group IV (n=27) -- >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Zinc (microg/dl) by Atomic Absorption Spectrometry using UNICAM - AA Spectrometer. MeanSD of Serum Zinc significantly reduced in all 3 contraceptive groups in comparison to controls (p<0.001). It was recommended to carry out further study including larger population from rural area to elucidate alteration in serum zinc and other trace elements to correlate with side effects caused by hormonal contraceptive so that attempt could be made to mitigate those.
Adolescent↗
Evaluation of hormone replacement therapy.
Hormone Replacement Therapy (HRT), once considered as the gold standard of treatment of menopausal symptoms and osteoporosis, introduced about seventy years ago still continuing with lot of controversies. Menopause, a transitional period of women's life, is not an illness when oestrogen level falls leading to its consequences. Results of earlier observational studies showed beneficial effects of HRT including cardiovascular protection. But all recent randomized controlled trials have failed to prove these positive effects, rather increases the cardiovascular risk and breast cancer. Women's Health Initiative(WHI), one of the recent randomized controlled trials was stopped prematurely in 2002 due to unfavorable risk-benefit ratio. HRT is not the only way of treating the menopausal symptoms and other consequences of estrogen deficiency. There are suitable alternatives without bearing the risk of HRT. Vasomotor symptoms with hot flushes and sweating experienced by about 75 percent of menopausal women can be treated with alternatives like phyto-estrogens, selective estrogen receptor modulators (SERMs), clonidine, selective serotonin reuptake inhibitors, acupuncture, exercise, behavioral therapy etc. HRT is no longer considered as the first line of treatment of postmenopausal osteoporosis. It can be treated with alternatives like regular weight bearing exercise, balanced calcium rich diet, maintaining weight, avoidance of bone robbers, (like excess alcohol, caffeine, smoking), use of SERMs etc. Use of HRT should be individualized and rationalized considering its risks and benefits.
Breast Neoplasms↗
Primary prevention of type 2 diabetes.
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Blood Glucose↗
Prevalence of antithyroid microsomal antibody in thyroid patients of endemic goitre area.
The region of greater Mymensingh known for iodine endemicity, recently came under iodine supplementation as a result of mandatory universal iodination of salt program. Autoimmune thyroid diseases (AITD) are among the most common human autoimmune disorders & presence of autoantibodies to the microsomal antigen (AntiMCAb) is a hallmark of disease activity. Both iodine deficiency & iodine supplementation precipitate increase rate of autoimmunity to the thyroid gland. Study was undertaken to determine prevalence of AntiMCAb positive cases among patients with various thyroid diseases. High resolution ultrasound (HRUS), serum thyroid hormone assays & scintiscan were used to classify the thyroid patients into 8 categories. 221 patients were studied during the stipulated period of 3 months. Male patients were 60 & female patients were 161. Age ranged from 11 to 65 years with median age 29.4 years. AntiMCAb test were done with radioimmunoassay (RIA). 126 patients had antimicrosomal antibody (57.01%). All form of hypothyroid (atrophic, goitrous, Hashimoto's) have very high rate of AntiMCAb positive cases. Highest 89.28% were seen in patients showing feature of Hashimoto's thyroiditis or generalized feature of AITD in HRUS with hypothyroidism, followed had 61.29% positive cases, However, antithyroid antibody was found in all form of thyroid disorders. Nodular goiter had 21.73% antiMCAb positive cases. AntiMCAb found positive at the rate of 33.33% in euthyroid patients with HRUS feature of AITD & diffuse euthyroid goiter, 40% in subclinical hypothyroid, 40% in subclinical hyperthyroid. Female rated higher in range of antimicrosomal antibody positivism. 59% of all thyroid patients among female subjects were AntMCAb positive, where as 51.67% male thyroid patients were positive. Highest number of positive cases found in the 30-35 age group. No definite pattern, however, was observed among age distribution. 20 age matched sample from patients unsuspected of thyroid disease shows 10% AntiMCAb positive compared to 73.33% of the same among same age group of thyroid patients. Frank Hashimoto's thyroiditis with positive antiMCAb and hypothyroidism were all detected by HRUS.
Adolescent↗
Coronary artery disease in young adults - angiographic profile.
Angiographic profile of fifty young patients of coronary artery disease aged 40 or under were analysed and compared with those of fifty older patients. Mean age of younger and older group was 36.34 (range 28 to 40 years) and 55.28 (44-74 years) years respectively and most of the patients were male in both the group (92 Vs 94%). Older patients were more diabetes (40 Vs 24%) and hypertensive (38 Vs 60%) but the younger patients had more family history of premature coronary artery disease (50% Vs 24%). The incidence of smoking and dyslipidemia did not vary between the two groups. Older patients had more history of myocardial infarction (69 Vs 58%) but angina were more in young patients (42 Vs 31%). Coronary angiography revealed more number of multivessel disease in older patients (74 Vs 54%) but the younger patients had more normal coronary arteries and single vessel disease (46 vs 26%). Coronary athesclerosis was also extensive in older patients as revealed by the higher coronary score, more involvement of coronary segments, more number of diseased and diffusely involved coronary vessel in older patients. Older patients needed more revasalarization process (74 Vs 60%), more coronary bypass surgery (40 Vs 24%) and had more inoperable vessels (16% Vs 4%) than the younger patients. So the younger patients having less extensive coronary artery athesclerosis with better prognostic probability should be evaluated angiographically for further definitive management in the from of revascularization.
Adult↗
Effect of prolonged use of injectable hormonal contraceptives on blood pressure and body weight.
The study was undertaken to determine the effect of prolonged use of injectable hormonal contraceptive on blood pressure and body weight in young women. Two hundred volunteers were selected for the purpose. Of them, one hundred and forty were taking injectable hormonal contraceptive, DMPA for 3 to 5 years uninterruptedly. Rest forty subjects served as control using no contraceptive steroid. Blood pressure, systolic as well as diastolic, was measured by sphygmomanometer. Body weight was measured by weighing machine. It was observed that there were insignificant (P>0.05) elevations of systolic and diastolic blood pressure from DMPA use. But body weight of the experimental subjects was significantly (P <0.05) increased in comparison to that of the control.
Adult↗
Studies on clinical pattern of glomerulonephritis.
A prospective study of primary glomerulonephritis covering two and half years period was done at Dhaka Medical College Hospital & IPGMR, Dhaka from June 90 to July 92. A total of 100 cases were included in this study. All of the patients were of 13 years and above, clinically diagnosed, and by laboratory investigations, the diagnoses were established. In this study, we have tried to find out age incidence, sex ratio, possible aetiological factors, common clinical presentation, biochemical parameters and histological typing of primary glomerulonephritis.
Acute Kidney Injury↗
Management of dengue by the WHO guided national guidelines.
A total of 90 adult patients of Dengue admitted in Sir Salimullah Medical College and Mitford Hospital, Dhaka during the period from July 2002 to December 2002 were studied to see the presentation, spectrum of disease and outcome of management. Majority (52%) of cases was in the age group 21-30 years. Out of 90 patients 74 patients (82.22%) were male and 16 (17.78%) were female. Maximum number of cases (43%) was found in the month of August. Most of the cases (77%) were from Dhaka City. Classical type of Dengue fever was the commonest (80%) variety. Thrombocytopenia was found in 80% cases. Platelet count came down below 10000/cumm only in 1.1% of the patients. The patients were diagnosed mainly by clinical criteria. Serological tests were done only in selected cases. Majority (80%) of the patients was managed by sponging, paracetamol and Oral Rehydration Salt (ORS). Blood transfusion was required in 18% cases and platelet concentrate was given only in 1.1% cases. There was no mortality in this study.
Acetaminophen↗
Tuberous sclerosis.
Tuberous sclerosis - also called tuberous sclerosis complex (TSC) - is a rare, multi-system genetic disorder affecting cellular differentiation & proliferation, which results in hamartoma formation in many organs. The classic triad of clinical features comprises mental retardation, epilepsy & skin lesion, but these three features are not always present. Mrs. Jahanara Khatun, a 30 years old lady presented with maculo-papular skin lesions over the face, neck, shoulder since her six years of age, a lump in the right lumber region for four years, pain in the right lumber region associated with passage of blood clot in urine for 15 days. Her family history was very characteristic. One of her elder brother had developed same type of skin lesions. Again her 13 years old daughter had developed same type of skin lesions since seven years of age & she was mentally retarded. Clinical examination revealed normal mentation, pin head sized yellowish red translucent discrete waxy papules situated in the face, neck, shoulder. A large tender firm irregular mass in the right lumber region, which was ballotable & moved with respiration. USG revealed bilateral retroperitoneal masses with the involvement of right kidney & formation of renal artery aneurysm. The patient undergone right sided nephrectomy & histopathology of the specimen showed features suggestive of renal angiomyolipoma. The patient was diagnosed as a case of definite tuberous sclerosis complex as she had two major feature of revised diagnostic criteria - facial angiofibromas & renal angiomyolipoma.
Adult↗
Thoracic actinomycosis.
Thoracic actinomycosis represents about one-fourth of all cases of the disease. Isolated pleural effusion due to Actinomycosis is rare. We report a case of right sided pleural effusion with discharging sinus in the right anterior chest wall. Actinomycosis was suspected and confirmed by microscopic identification of "sulfur granules" in the discharge of the sinus tract and also identification of gram-positive filamentous bacteria in the specimen of discharging sinus. The patient improved clinically and radiologically after treatment with intravenous penicillin G followed by oral penicillin and aspiration of pleural fluid.
Actinomycosis↗
Obesity management in patients with type 2 diabetes mellitus.
Obesity infrequently associated with type 2 diabetes mellitus and may cause insulin resistance, hypertension and other complications of obesity. So obesity management in Type 2 diabetes mellitus is essential. Prevention is a logical first step in the management of the obese Type 2 diabetic patient, such programs have had little long-term success. Diet, exercise and behavioral modification still form the cornerstones of treatment and relatively small weight loss results in improvement of all major obesity related co-morbidity's, including Type 2 diabetes. The obese diabetic patient faces extra impediments to weight loss, including the adverse effects of diabetic medication, poor glycaemic control and diabetes related complications. New drugs may offer some additional help, in general by providing the benefit associated with the weight loss as such, Bariatric surgery can produce major long-term weight loss in the severely obese subjects.
Cyclobutanes↗
Ketosis resistance in under thirty diabetic subjects.
Young onset diabetic subjects in tropical developing countries include a group of subjects who exhibits a characteristic ketosis resistance termed as Malnutrition Related Diabetes Mellitus (MRDM) by the WHO Study Group. The mechanism for this resistance to ketosis is still uncertain. To understand this mechanism we have studied the serum responses of glucose, non-esterified fatty acid (NEFA) and triglyceride (TG) to intravenous fat emulsion in newly diagnosed 8 fibrocalculous pancreatic diabetes (FCPD) and 11 low insulin secretory (LIS) subjects under 30 years of age along with 27 age-matched Non Insulin Dependent Diabetes Mellitus (NIDDM) subjects. Overnight fasting subjects were given a 90 min infusion of intralipos 10% (2.5 mg/kg body weight/min) and serum was collected at 0, 60, 90, 120 and 150 min. The fasting NEFA in the 3 groups were almost similar (micromol/l, M +/- SEM: 486 +/- 58, 564 +/- 76 and 559 +/- 34 in FCPD, LIS and NIDDM respectively). Fasting TG also showed a close similarity among 3 groups (mg/dl, M+/-SEM: 117 +/- 11, 110 +/- 22 and 123 +/- 4 in FCPD, LIS and NIDDM respectively). Intravenous fat caused a steady rise of NEFA as well as TG in all groups during the 90 minutes of infusion followed by a gradual fall. No two groups significantly differed regarding NEFA and TG at any time point. Fasting glucose was markedly higher in FCPD (22.9 +/- 2.5, mmol/l, M+/-SEM) and LIS (20.8 +/- 1.6) than NIDDM (11.0 +/- 1.0). In all the 3 groups glucose showed a slow but steady fall. Fasting C-peptide was very low in FCPD (0.42 +/- 0.08, ng/ml, M +/- SEM) and LIS (0.55 +/- 0.09) whereas it was within normal range in NIDDM patients (2.99 +/- 0.24). The results suggest the following: (a) Depleted body fat store do not lead to a decreased supply of NEFA in FCPD and LIS subjects at the fasting state; (b) Increased supply of NEFA in these subjects lead to a normal esterification response as evidenced by a parallel rise of TG; (c) Inspite of markedly low level of the antilipolytic hormone insulin, FCPD and LIS subjects are capable to maintain NEFA and TG responses similar to NIDDM subjects. This may indicate that factor (s) other than substrate and esterification is (are) probably involved in the ketosis resistance of FCPD and LIS subjects; and (d) Although FCPD and LIS differ regarding generalized pancreatic damage (which raises the possibility of involvement of glucagon producing alpha-cells in the FCPD group) the two groups do not differ regarding the ketogenic substrate and esterfication responses.
Adult↗